| NPI | 1902938467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 66998) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WI 50452) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 50452020) | |
| Enumeration Date | 2007-03-11 |
| Last Update Date | 2020-08-13 |